Polymerase chain reaction for human parechovirus on blood samples improves detection of clinical infections in infants

Human parechovirus (HPeV) is an emerging pathogen for infants. Improved diagnostics are needed due to the non-specific clinical presentation. Real-time reverse transcription polymerase chain reaction (RT-PCR) on blood samples may be an adjunct to diagnosis. A retrospective cohort of HPeV-affected infants was used to assess sensitivity and specificity of a HPeV RT-PCR on blood and cerebrospinal fluid (CSF). As a secondary analysis, the Ct value of the PCR results was compared to clinical correlates of severity. Between 2017 and 2018 blood samples were obtained from 97 infants of whom 44 had HPeV clinical and laboratory proven infection. Eighty-three concurrent CSF samples were available. Sensitivity was 93.3% [95% CI 82-99] for blood HPeV RT-PCR and 85% [95% CI 73.9-96.1] for CSF HPeV RT-PCR. Blood HPeV RT-PCR Ct values < 25 cycles were associated with age < 28 days and < 3 days of symptoms. No statistical associations were identified between potential clinical markers of severity and Ct value. HPeV RT-PCR on blood is a valuable adjunct to diagnostic testing for acute HPeV-related illness in infants. Results can be expected to be robust until at least day 5 of symptoms, with optimal sampling occurring close to onset of symptoms.